Dental Provision in Portsmouth

On Friday, 23rd July, I wrote to Anne Eden, the Regional Director for NHS Improvement and NHS England South East regarding Dental Provision in Portsmouth.

Dear Ms Eden

Re: Dental Provision in Portsmouth

I write following previous correspondence with your office in respect of the concerns I have been fielding from constituents regarding access to an NHS Dentist in the city.

It follows previous concerns I raised in respect of the closure of three practices in the city in 2019 after Colosseum Dental ceased operating with no prior warning given – affecting approximately 20,000 patients.

Whilst, two contracts have now been awarded I am very concerned that due to the time taken to tender these contracts (owing to the Covid pandemic) that it is unlikely to meet demand for both urgent and routine NHS dentist appointments.

I raised concerns during both lockdowns in respect of constituent’s difficulty in securing urgent dental treatment.

A number of constituents were left in significant pain and risk of serious infection without clear direction from either NHS 111 or their dentist with regard to next steps.

Whilst, your assurances in respect of the provision of Urgent Treatment Hubs during this period was welcome it is unlikely to have been enough to alleviate the pressures being faced by practices as they seek to operate in a Covid secure way (at reduced capacity) in order to meet current demand and I am very worried as to the implications for residents in respect of their short and long term oral health. It is in my view a perfect storm of pressures unique to Portsmouth.

In February of this year I wrote to you with a constituent’s concerns in respect of their experience in trying to secure NHS Treatment. The constituent advised that they had been unable to secure an appointment with their regular dentist as they had not attended the practice for a year; and had subsequently been removed from the practice list. At the time the dental practice mistakenly advised the constituent that an NHS England policy allowed for their removal from the register. In your reply to my office in respect of the case you kindly clarified the miscommunication from the dental practice and advised that patients did not need to be registered with an NHS dentist in order to secure NHS treatment.

As you will be aware the constituent had significant tooth ache and approached a number of other practices in the city for assistance. During the constituent’s enquiries with dental practices in the city it had been suggested to the constituent that they could obtain treatment if they were willing to pay (seek private treatment). This is wholly wrong and I was very concerned to learn of similar concerns from other constituents at that time; one in particular where it was suggested that a family with a small child would be considered for NHS treatment if they registered with a practice on a private basis, first. The child in this case was of infant school age and I am sure you would agree with me the import of being able to access an NHS dentist not only at a young age but also regularly to ensure good future oral health. It is vitally important given that we know that good oral health is part of a healthy lifestyle, and routine appointments provide an indicator in respect of other health issues a patient may be experiencing; which requires other treatment.

I suggested at the time it might be sensible to reiterate to all practices operating in the city their obligations in respect of the provision of NHS dental treatment; and that an audit or similar should be carried out. From the acknowledgements I have received from your office it does seem that the issues being experienced are well understood and a need for a different approach is required; however, I am yet to see further changes which would benefit the residents of Portsmouth.

I continue to receive concerns from constituents advising of their difficulty in securing access to an NHS Dentist and I enclose further emails I have received outlining these difficulties with many of the themes I have previously raised still present. It is particularly concerning to me the continued suggestion by some practices that patients can obtain treatment if they are willing to pay privately; with it being inferred that there might be the possibility to register as an NHS patient, if they do so.

Furthermore, I am also receiving concerns where when a patient is able to see their NHS patient it is being suggested that they can secure more timely treatment if they were to consider paying privately; in conjunction, with the details of finance plans being provided to them. This particularly appears to be the case in incidents where the treatment required is of an urgent nature, or likely to be expensive. Patients should be able to access NHS treatment for both urgent and expensive treatment and I find the suggestion that it is being implied to patients that they can access the treatment they need if they were to consider paying privately very concerning.

Whilst not associated to general dentistry it is also worth mentioning I have also recently raised my concerns in respect of the closure of Dolphin Orthodontics resulting in a young person being left without access to an orthodontist for at least three months; potentially longer on account of the fact that routine check-ups are not considered to be an urgent need. They would ordinarily receive a check up every eight weeks, and when I communicated with your office, recently they were already overdue their check-up.

The patient is currently waiting to understand how and when they will be referred elsewhere. It is not acceptable that corrective maxillofacial work of this kind can be left without ongoing/continual assessment and correction, particularly at such a formative stage in a young person’s development. I suspect there will be a number of other patients similarly affected also and whilst I recognise the need to ensure that all patients at this practice are transferred in a coherent manner; the length of time this will take to do so overlooks the needs of the patients; and the moral obligations of the NHS to provide treatment.

Despite previous assurances that there is no need for an individual to be registered with an NHS dentist in order to secure NHS dental treatment this is clearly not borne out by patient experience and it is evident from the communications I am receiving from constituents that the reasoning for dental practices directing patients elsewhere is on the grounds that they are not registered as a patient, or patients are being advised that are no longer registered as a patient, either because they have missed an appointment, or haven’t arranged for an appointment for a period of time.

When I have spoken with constituents in respect of these points this is evidently not the case and it was the reason why I requested an audit take place or that a reminder is sent to all dentists in respect of their obligations in respect of NHS treatment.

Despite the efforts of NHS England to secure additional capacity on a temporary basis (following the closure of Colosseum) through additional funding there appears to be little incentive for dentists to treat patients via the NHS and I am also receiving reports of dentists choosing to go wholly private or elsewhere where funding for NHS treatment is higher which is only likely to further reduce capacity in the system. Patients deserve better.

I am very aware from your prior correspondence that UDA’s in Portsmouth are largely in line with the national data in respect of dental activity, access and treatment; however; patients are indicating this is not their experience as they struggle to be seen by an NHS dentist and urgent action is needed to provide the capacity needed in the system.

Patients should be able to access the urgent and or expensive treatment they need via the NHS without undue delay; and I would be grateful if you would consider the contents of the enclosed carefully.

Yours sincerely

Penny Mordaunt MP

Portsmouth North